The goal of the proposed five-year program of research is to implement and evaluate interventions designed to address underage alcohol consumption among Native American youth residing in and around 9 contiguous Indian reservations in rural San Diego County. The application directly builds upon the successful collaboration between Indian Health Center, Inc. (the clinics serving these tribes), the Prevention Research Center, and The Scripps Research Institute. This team assessed the extent of alcohol-related problems in these underage populations of Southwest California Indians and established the groundwork for selecting, implementing, and evaluating appropriate prevention and treatment interventions to reduce drinking among its youth. The overall goal of the present proposal will be accomplished through two complementary efforts, one aimed at the community level and the other at the individual level. The community-based environmental prevention program will focus on a) reducing underage access to alcohol through a reward and reminder program for off-premise retail clerks, backed by increased compliance checks and b) preventing underage drinking and driving through highly publicized low-manpower checkpoints by tribal, local, and state law enforcement. To mobilize the community, these programs will be supported by Indian Health Council doctors and tribal leaders and local community coalitions. These community-level programs will be complemented with interventions at the individual level, including a) screening tribal youth for alcohol involvement and b) offering brief interventions by clinic staff in the form of a controlled trial of motivational interviewing with youths who report underage drinking. These individual level interventions will be culturally tailored to appropriately address drinking by Native American youths from the nine tribes. We will evaluate the effectiveness of these programs by analyzing multiple data sources: a) outcome data from the Motivational Interviewing trial among tribal youth, b) data from school and community youth surveys on youths' self-reported drinking and drinking problems, c) emergency room discharge data, and d) law enforcement data on alcohol-related events. For the purposes of evaluation, these data from the Indian Health Council catchment area will be compared to data from surveys of Native American youth who were not involved in the intervention activities. Once the project is completed, the results will be reported to representatives of the nine tribes as well as the comparison groups and other community stakeholders such as law enforcement and agencies serving youths and families. PUBLIC HEALTH RELEVANCE: Building upon successful capacity building efforts, the proposed 5 year study will implement and evaluate interventions designed to address underage alcohol consumption and problems in and around 9 Indian reservations in rural San Diego County. The proposed interventions integrate community based environmental underage alcohol access and DUI prevention programs with individual screening and motivational interviewing in a culturally appropriate way. This project offers significant potential reductions in immediate as well as long-term harm resulting from underage drinking among rural Native Californians.